Sars-Cov-2 Hastalarında Prognozun Öngörülmesine Yeni Bir Yaklaşım ‘MELD Skorlaması’

Amaç: MELD skoru, son dönem karaciğer hastalığının şiddetini değerlendirmek için kullanılan bir skorlama sistemidir. Çalışmamızda multisistem tutulumu olan COVID-19 hastalığında MELD skorunun hastalığın seyrini ve mortaliteyi tahmin etmedeki rolünü araştırmayı amaçladık. Gereç ve Yöntem: Çalışmamız Mart 2021 – Mart 2022 tarihleri arasında nazaofaringeal sürüntü alınarak real time PCR metoduyla COVİD-19 tanısı alan 18 yaş üstü 96 hasta ile yapılmıştır. MELD skoru hastaların hastaneye yatış anındaki kan sonuçlarına göre hesaplandı. MELD puanını hesaplamak için şu denklem kullanıldı: MELD = 11,2 x ln(uluslararası normalleştirilmiş oran [INR]) + 3,78 x ln(bilirubin, mg/dL olarak) + 9,57 x ln(kreatinin, mg/dL olarak) + 6,43. Bulgular: MELD skorunun orta ve şiddetli hasta grubunda hafif hasta grubuna göre anlamlı olarak yüksek olduğunu bulduk (p<0.01). Orta ve ağır hasta gruplarını kendi aralarında karşılaştırdığımızda şiddetli hasta grubunda MELD skoru anlamlı olarak daha yüksekti (p<0.01).MELD skorunun mortalite ile ilişkisinin değerlendirilmesinde, MELD skorundaki bir birimlik artış, 1.26 kat (%95 güven aralığı: 1.10-1.44) artmış mortalite riski ile ilişkilendirildi. Sonuç: COVID-19 hastalarında MELD skorunu değerlendiren çalışmamızda hastanede yatış sırasındaki MELD skorunun hastalık şiddeti ve mortalite ile yakından ilişkili olduğu gözlendi. Bu nedenle MELD skoru, COVID-19 hastalarının erken takibinde yol gösterici bir skorlama sistemi olabilir.

Anahtar Kelimeler:

MELD, COVID-19, Mortalite

A New Approach To Predicting Prognosis In Sars-Cov-2 Infection: "MELD Scoring"

Background/Aims: The MELD score is a scoring system used to assess the severity of end-stage liver disease. In our study, we aimed to investigate the role of MELD score in predicting the course of the disease and mortality in COVID-19 disease with multi-systemic involvement. Methods: Our study was conducted with 96 patients over the age of 18 who were diagnosed with COVID-19 by real time PCR method by taking nasopharyngeal swabs between March 2021 and March 2022. MELD score was calculated according to the blood results of the patients at the time of hospital admission. To calculate the MELD score, the equation MELD = 11.2 x ln(international normalized ratio [INR]) + 3.78 x ln(bilirubin, mg/dL) + 9.57 x ln(creatinine, mg/dL) + 6.43 was used. Results: We found that the MELD score was significantly higher in the moderate and severe patient group compared to the mild patient group (p<0.01). When we compared the moderate and severe patient groups between themselves, the MELD score was significantly higher in the severe patient group (p<0.01). In the evaluation of the association of MELD score with mortality, a one-unit increase in MELD score was associated with a 1.26-fold (95% confidence interval: 1.10-1.44) increased mortality risk. Conclusions: In our study evaluating the MELD score in COVID-19 patients, it was observed that the MELD score during hospitalization was closely associated with disease severity and mortality. Therefore, the MELD score may be a guiding scoring system in the early follow-up of COVID-19 patients.

Keywords:

MELD, COVID-19, Mortality,

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Conti P, Ronconi G, Caraffa A, Gallenga CE, Ross R, Frydas I, et al. Induction of pro-inflammatory cytokines (IL-1 and IL-6) and lung inflammation by Coronavirus-19 (COVI-19 or SARS-CoV-2): anti-inflammatory strategies. J Biol Regul Homeost Agents. 2020;34(2):327-31.
King JT, Jr., Yoon JS, Bredl ZM, Habboushe JP, Walker GA, Rentsch CT, et al. Accuracy of the Veterans Health Administration COVID-19 (VACO) Index for predicting short-term mortality among 1307 US academic medical centre inpatients and 427 224 US Medicare patients. J Epidemiol Community Health. 2022;76(3):254-60.
Rahman T, Al-Ishaq FA, Al-Mohannadi FS, Mubarak RS, Al-Hitmi MH, Islam KR, et al. Mortality Prediction Utilizing Blood Biomarkers to Predict the Severity of COVID-19 Using Machine Learning Technique. Diagnostics (Basel). 2021;11(9).
Tiscia G, Favuzzi G, De Laurenzo A, Cappucci F, Fischetti L, Colaizzo D, et al. The Prognostic Value of ADAMTS-13 and von Willebrand Factor in COVID-19 Patients: Prospective Evaluation by Care Setting. Diagnostics (Basel). 2021;11(9).
Kermali M, Khalsa RK, Pillai K, Ismail Z, Harky A. The role of biomarkers in diagnosis of COVID-19–A systematic review. Life sciences. 2020;254:117788.
Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33(2):464-70.
Kamath PS, Kim WR. The model for end-stage liver disease (MELD). Hepatology. 2007;45(3):797-805.
Stawinski PM, Dziadkowiec KN, Al-Abbasi B, Suarez L, Simms L, Dewaswala N, et al. Model of End-Stage Liver Disease (MELD) Score as a Predictor of In-Hospital Mortality in Patients with COVID-19: A Novel Approach to a Classic Scoring System. Cureus. 2021;13(5):e15179.
Wernly B, Frutos-Vivar F, Peñuelas O, Raymondos K, Muriel A, Du B, et al. Easy prognostic assessment of concomitant organ failure in critically ill patients undergoing mechanical ventilation. Eur J Intern Med. 2019;70:18-23.
Bruno RR, Wernly B, Hornemann J, Flaatten H, FjØlner J, Artigas A, et al. Early evaluation of organ failure using MELD-XI in critically ill elderly COVID-19 patients. Clin Hemorheol Microcirc. 2021;79(1):109-20.
AKDOĞAN M, ÖZÇAY N, DOĞRUCAN N, KAÇAR S, KAYHAN B, KILIÇ ZMY, et al. Karaciğer transplantasyon önceliğini belirlemede hangi model etkin; MELD skoru? CHILD Skoru? Akademik Gastroenteroloji Dergisi. 2008;7(2):73-6.
Bakanliği TS. COVID-19 (SARS-CoV2 Enfeksiyonu) Rehberi. Erişim: https://covid19bilgi saglik gov tr/depo/rehberler/COVID-19_Rehberi pdf (Erişim Tarihi: 1607 2020). 2020.
Ragab D, Salah Eldin H, Taeimah M, Khattab R, Salem R. The COVID-19 Cytokine Storm; What We Know So Far. Front Immunol. 2020;11:1446.
Jung C, Wernly B, Fjølner J, Bruno RR, Dudzinski D, Artigas A, et al. Steroid use in elderly critically ill COVID-19 patients. Eur Respir J. 2021;58(4).
Sacleux S-C, Samuel D, editors. A critical review of MELD as a reliable tool for transplant prioritization. Seminars in liver disease; 2019: Thieme Medical Publishers.
Biegus J, Zymliński R, Sokolski M, Siwołowski P, Gajewski P, Nawrocka-Millward S, et al. Impaired hepato-renal function defined by the MELD XI score as prognosticator in acute heart failure. Eur J Heart Fail. 2016;18(12):1518-21.
He PC, Wei XB, Luo SN, Chen XL, Ke ZH, Yu DQ, et al. Risk prediction in infective endocarditis by modified MELD-XI score. Eur J Clin Microbiol Infect Dis. 2018;37(7):1243-50.
Wernly B, Lichtenauer M, Franz M, Kabisch B, Muessig J, Masyuk M, et al. Model for End-stage Liver Disease excluding INR (MELD-XI) score in critically ill patients: Easily available and of prognostic relevance. PLoS One. 2017;12(2):e0170987.
Rezar R, Lichtenauer M, Schwaiger P, Seelmaier C, Pretsch I, Ausserwinkler M, et al. Thinking fast and slow: lactate and MELD-XI (model for end-stage liver disease excluding INR) are useful for estimating mortality after cardiopulmonary resuscitation. Minerva Anestesiol. 2021;87(9):1017-24.
Hu B, Huang S, Yin L. The cytokine storm and COVID-19. J Med Virol. 2021;93(1):250-6.
Kerget B, Kerget F, Aksakal A, Aşkın S, Sağlam L, Akgün M. Evaluation of alpha defensin, IL-1 receptor antagonist, and IL-18 levels in COVID-19 patients with macrophage activation syndrome and acute respiratory distress syndrome. J Med Virol. 2021;93(4):2090-8.
Amraei R, Rahimi N. COVID-19, Renin-Angiotensin System and Endothelial Dysfunction. Cells. 2020;9(7).
Chai X. Hu l, Zhang y, Han W. Lu Z, Ke A, et al Specific ACE2 expression in cholangiocytes may cause liver damage after. 2019.
Roth JA, Widmer AF, Tschudin-Sutter S, Dangel M, Frei R, Battegay M, et al. The Model for End-stage Liver Disease (MELD) as a predictor of short-term mortality in Staphylococcus aureus bloodstream infection: A single-centre observational study. PLoS One. 2017;12(4):e0175669.
Yip TC, Chan HL, Tse YK, Lam KL, Lui GC, Wong VW, et al. On-Treatment Improvement of MELD Score Reduces Death and Hepatic Events in Patients With Hepatitis B-Related Cirrhosis. Am J Gastroenterol. 2018;113(11):1629-38.
İdin K, Dereli S, Kaya A, Yenerçağ M, Yılmaz AS, Tayfur K, et al. Modified model for end-stage liver disease score predicts 30-day mortality in high-risk patients with acute pulmonary embolism admitted to intensive care units. Scand Cardiovasc J. 2021;55(4):237-44.
Kaya Y, Gülcü O, Aksakal E, Kalkan K, Aydın S, Kaya A, et al. A significant predictor of in-hospital and long-term mortality and progression in COVID-19 patients: The end-stage liver disease (MELD) score model. J Med Virol. 2023;95(1):e28109.
Çiftci O, Çelik Ç O, Uzar G, Küpeli E, Müderrisoğlu İ H. MELD-XI score predicts in-hospital mortality independent of simplified pulmonary embolism severity index among patients with intermediate-to-high risk acute pulmonary thromboembolism. Tuberk Toraks. 2019;67(3):169-78.
Chen Y, Klein SL, Garibaldi BT, Li H, Wu C, Osevala NM, et al. Aging in COVID-19: Vulnerability, immunity and intervention. Ageing Res Rev. 2021;65:101205.
Basta G. Direct or indirect endothelial damage? An unresolved question. EBioMedicine. 2021;64:103215.
Cheng L, Li H, Li L, Liu C, Yan S, Chen H, et al. Ferritin in the coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. J Clin Lab Anal. 2020;34(10):e23618.